| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic service |
17,101 |
15,869 |
$2.51M |
| 00003 |
|
5,386 |
4,779 |
$1.00M |
| 99214 |
|
7,911 |
7,185 |
$63K |
| 90834 |
|
1,359 |
483 |
$53K |
| 99204 |
|
523 |
375 |
$14K |
| 92004 |
|
499 |
386 |
$14K |
| 99213 |
|
4,243 |
4,001 |
$12K |
| 90832 |
|
349 |
156 |
$11K |
| V2020 |
Vision svcs frames purchases |
808 |
659 |
$10K |
| 99203 |
|
235 |
159 |
$6K |
| 92014 |
|
351 |
283 |
$6K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
509 |
307 |
$5K |
| 92015 |
|
981 |
800 |
$4K |
| 87811 |
|
3,413 |
3,156 |
$4K |
| 87804 |
|
2,922 |
2,639 |
$3K |
| 99205 |
Prolong outpt/office vis |
21 |
13 |
$2K |
| V2784 |
Lens polycarb or equal |
505 |
265 |
$2K |
| 87880 |
|
2,118 |
1,963 |
$1K |
| 99215 |
Prolong outpt/office vis |
487 |
471 |
$1K |
| 96110 |
|
27 |
15 |
$1K |
| 59425 |
|
26 |
19 |
$532.22 |
| V2100 |
Lens spher single plano 4.00 |
39 |
25 |
$329.40 |
| H1003 |
Prenatal at risk education |
13 |
13 |
$279.00 |
| G9920 |
Scrning perf and negative |
140 |
138 |
$261.05 |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
20 |
13 |
$234.64 |
| 87807 |
|
326 |
298 |
$231.39 |
| 81003 |
|
808 |
751 |
$211.00 |
| 92133 |
|
29 |
28 |
$141.60 |
| 99391 |
|
23 |
20 |
$138.76 |
| 96372 |
|
555 |
545 |
$124.65 |
| G0467 |
Fqhc visit, estab pt |
495 |
437 |
$117.40 |
| 92551 |
|
436 |
430 |
$93.50 |
| 99000 |
|
133 |
126 |
$74.28 |
| 99394 |
|
89 |
88 |
$65.80 |
| 85018 |
|
952 |
937 |
$40.59 |
| 81025 |
|
35 |
29 |
$19.60 |
| 99212 |
|
29 |
29 |
$18.10 |
| 83036 |
|
29 |
29 |
$10.25 |
| J1885 |
Ketorolac tromethamine inj |
27 |
24 |
$5.04 |
| 36416 |
|
982 |
980 |
$0.00 |
| 90471 |
|
294 |
294 |
$0.00 |
| 36415 |
|
130 |
129 |
$0.00 |
| 96127 |
|
44 |
43 |
$0.00 |
| 3080F |
|
41 |
41 |
$0.00 |
| Z6410 |
|
90 |
46 |
$0.00 |
| J0561 |
Penicillin g benzathine inj |
14 |
14 |
$0.00 |
| V2782 |
Lens, 1.54-1.65 p/1.60-1.79g |
133 |
73 |
$0.00 |
| 96160 |
|
204 |
163 |
$0.00 |
| 3077F |
|
317 |
305 |
$0.00 |
| 1159F |
|
3,615 |
3,408 |
$0.00 |
| 1160F |
|
3,615 |
3,408 |
$0.00 |
| 99392 |
|
31 |
31 |
$0.00 |
| 99173 |
|
452 |
452 |
$0.00 |
| 59426 |
|
20 |
18 |
$0.00 |
| 81002 |
|
25 |
23 |
$0.00 |
| 90472 |
|
115 |
115 |
$0.00 |
| J7510 |
Prednisolone oral per 5 mg |
15 |
15 |
$0.00 |
| S0119 |
Ondansetron 4 mg |
16 |
16 |
$0.00 |
| 99393 |
|
37 |
37 |
$0.00 |
| Z6400 |
|
20 |
20 |
$0.00 |
| 99188 |
|
16 |
16 |
$0.00 |
| A4649 |
Surgical supplies |
15 |
15 |
$0.00 |